Good prescribing practices start well before a patient is given a prescription. Informed consent is one of the foremost things that should be obtained and documented to ensure legal treatmen
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In this case study we are presented with a young female who seems to be suffering from depression. Supporting symptoms for this include weight loss, guilt, persistent sadness, insomnia, and difficulty concentrating. It is also discovered that she is biracial, comes from a Jamaican family, and has used herbal teas in the past for treatment.
Good prescribing practices start well before a patient is given a prescription. Informed consent is one of the foremost things that should be obtained and documented to ensure legal treatment and that prescribing can be done. An in-depth medical history and pertinent physical and mental exam are needed at the appointment for diagnosis and initiating treatment. Before prescribing a provider should note any previous treatment with response, current medications, allergies, suicide risk, pregnancy status, alcohol use, and substance use. We should also ask our patient what their views on medications and herbal treatments are to improve medication adherence along with any other concerns she may have. Depicting feelings and concerns about her situation can guide education and select the best individual treatment plan. An accurate diagnosis is then also needed before prescribing a medication for treatment.
Once the diagnosis is made then the correct medication can be selected. Written prescriptions need the patients information, medication name, route, frequency, amount dispensed, number of refills, and provider signature. Good prescribing will also consider the patients individual cultural needs and adjust as implicated. Extensive education is particularly needed when starting a new medication. Our patient should be informed of the medications use, possible side effects, adverse effects, and how to correctly take the medication. Written instructions and education should also be provided. Patients should be informed that many psychiatric medications may take some time to work, and they should not be abruptly discontinued. If questions or concerns arise, they should contact their provider and follow up appointments are essential to monitor treatment.
The unique Jamaican culture often will partake in traditional medicine and favor medicinal plant use for many different diseases and symptoms. Today around seventy three percent of Jamaicans will self-medicate with plant-based therapies, and many will also not disclose this to their medical providers (Picking et al., 2019). One study on Jamaicans with hypertension and diabetes mellitus found that one-third believed that herbs were more effective and should always be used instead of prescription medications (Adeniyi et al., 2021). Our patient has previously relied on herbal treatments and has never used a psychiatrist. She may have a strong preference for herbal remedies which may affect medication adherence. Other possible issues that may affect adherence include fear of adverse reactions, lack of education, financial difficulties, and side effects. We should assess our patients views on taking medication and alternative medicine. After assessing we can educate and explain the importance of treatment and medication adherence. One study examined Jamaican patients with mental illnesses on their views on traditional and western practitioners and found that they believed the traditional practitioners took more time to listen and explain the problem and had an overall greater understanding of the problem (James & Peltzer, 2011). Listening and explaining are relatively easy interventions that can have a tremendous impact on the necessary treatment adherence.
References
Adeniyi, O., Washington, L., Glenn, C. J., Franklin, S. G., Scott, A., Aung, M., Niranjan, S. J., & Jolly, P. E. (2021). The use of complementary and alternative medicine among hypertensive and type 2 diabetic patients in Western Jamaica: A mixed methods study.?PloS one,?16(2) 1-15. https://doi.org/10.1371/journal.pone.0245163
James, C. C., & Peltzer, K. (2011). Traditional and alternative therapy for mental illness in Jamaica: patients’ conceptions and practitioners’ attitudes.?African journal of traditional, complementary, and alternative medicines: AJTCAM,?9(1), 94104. https://doi.org/10.4314/ajtcam.v9i1.14
Picking, D., Delgoda, R., & Vandebroek, I. (2019). Traditional knowledge systems and the role of traditional medicine in Jamaica.?CABI Reviews,?14(045), 113. https://doi.org/10.1079/pavsnnr201914045
Discuss how the principles of good prescribing should be applied to this case.
Good prescribing practices in healthcare have significant benefits, including maximizing the medication’s effectiveness, respecting the patient’s treatment choices, and reducing the risks and costs involved (Howard et al., 2020). The presented case involves a young biracial female who has lost weight over the last weeks, feels guilt about her symptoms, has everyday sadness, and has difficulty sleeping and concentrating. Application of good prescribing principles, in this case, includes considering the patient’s medication history before prescribing the correct treatment. The patient has not used medication before to treat the presenting symptoms as she has never consulted a psychiatrist, but her family has used herbal teas in the past to reduce these symptoms.
Another good prescribing principle that should be applied includes the healthcare professional considering factors that might interfere with the benefits and risks expected from the prescribed medication (Howard et al., 2020). These factors include physiological changes related to age, as the patient is a young biracial female who will experience physiological changes as she ages. The healthcare professional should also consider the patient’s treatment expectations, as the patient’s family is Jamaican and has been using herbal teas to treat the symptoms rather than consulting a psychiatrist. Another principle includes the doctor selecting the right medication after considering the symptoms presented by the patient. Factors that led to the prescription should be explained to the patient so that she understands and agrees with them. The physician should select an appropriately safe, affordable treatment that meets the patient’s expectations. In addition, the physician should inform the patient of the benefits and risks associated with the medication and identify how these benefits and risks can be assessed.
Describe a cultural consideration that may affect medication adherence for this patient.
Cultural beliefs and practices significantly affect how the patient responds to treatment and adheres to prescribed medication. Therefore, it is crucial for healthcare providers to understand the patient’s culture and incorporate culturally appropriate interventions to improve patient outcomes and adherence to medication (Shahin et al., 2019). The cultural considerations in this case that may affect the patients adherence to medication include her originating from a Jamaican family with a history of using herbal teas to treat symptoms and not consulting a psychiatrist. This might affect the patient’s adherence to medication, especially if the prescribed medication does not produce the desired effects in reducing the symptoms presented by the patient. Therefore, it is crucial for the healthcare provider to familiarize themselves with the patient’s culture, assess the likelihood of the patient adhering to prescribed medications, and come up with the appropriate interventions.
The cultural background of the patient’s family involves practices that promote the use of alternative medicine, and this may affect her adherence to the prescribed medication. For example, her Jamaican family, in this case, uses herbal teas to reduce the symptoms of the disease instead of consulting a psychiatrist. In conjunction with the poor understanding of the disease, symptoms denial, and high cost of medications, this cultural practice may lower the chances of the patient adhering to the prescribed medication (Shahin et al., 2019). Furthermore, the patient’s cultural background may have impacted her response to the disorders symptoms as she complains of feeling guilty about her symptoms. Therefore, it is important for a healthcare provider to identify cultural barriers that may impact adherence to prescribed medication and address them. The physician should also address the patient’s concerns that stem from her cultural background to ensure that the patient will be comfortable taking the prescribed medications and improve the adherence rates. They should also prescribe medications compatible with the patient’s cultural beliefs after assessing the risks and benefits that may result from medication use.
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